2011 Ohio Revised Code
Title [51] LI PUBLIC WELFARE
Chapter 5111: MEDICAL ASSISTANCE PROGRAMS
5111.244 Quality incentive payment for qualifying nursing facilities.

(A) As used in this section, “deficiency” and “standard survey” have the same meanings as in section 5111.35 of the Revised Code.

(B) The department of job and family services shall pay the provider of each nursing facility a quality incentive payment. The amount of a quality incentive payment paid to a provider shall be based on the number of points the provider’s nursing facility is awarded for meeting accountability measures. The amount of a quality incentive payment paid to a provider of a nursing facility that is awarded no points may be zero.

(C)(1) For fiscal year 2012 only and subject to division (C)(2) of this section, the department shall award each nursing facility participating in the medicaid program points for meeting the following accountability measures :

(a) The facility had no health deficiencies on the facility’s most recent standard survey.

(b) The facility had no health deficiencies with a scope and severity level greater than E, as determined under nursing facility certification standards established under Title XIX, on the facility’s most recent standard survey.

(c) The facility’s resident satisfaction is above the statewide average.

(d) The facility’s family satisfaction is above the statewide average.

(e) The number of hours the facility employs nurses is above the statewide average.

(f) The facility’s employee retention rate is above the average for the facility’s peer group established in division (C) of section 5111.231 of the Revised Code.

(g) The facility’s occupancy rate is above the statewide average.

(h)

The facility’s case-mix score is above the statewide average.

(i) The facility’s medicaid utilization rate is above the statewide average.

(2) A nursing facility shall be awarded one point for each of the accountability measures specified in divisions (C)(1)(a) to (h) of this section that the nursing facility meets. A nursing facility shall be awarded three points for meeting the accountability measure specified in division (C)(1)(i) of this section. The department shall award points pursuant to division (C)(1)(c) or (d) of this section to a nursing facility only if a survey of resident or family satisfaction was conducted under section 173.47 of the Revised Code for the nursing facility in calendar year 2010.

(D)(1) For fiscal year 2013 and thereafter, the department shall award each nursing facility participating in the medicaid program points for meeting accountability measures in accordance with amendments to be made to this section not later than December 31, 2011, that provide for all of the following:

(a) Meaningful accountability measures of quality of care, quality of life, and nursing facility staffing;

(b) The maximum number of points that a nursing facility may earn for meeting accountability measures;

(c) A methodology for calculating the quality incentive payment that recognizes different business and care models in nursing facilities by providing flexibility in nursing facilities’ ability to earn the entire quality incentive payment;

(d) A quality bonus to be paid at the end of a fiscal year in a manner that provides for all funds that the general assembly intends to be used for the quality incentive payment for that fiscal year are distributed to nursing facilities.

(2) For the purpose of division (D)(1)(d) of this section, the amount of funds that the general assembly intends to be used for the quality incentive payment for a fiscal year shall be the product of the following:

(a) The number of medicaid days in the fiscal year;

(b) The maximum quality incentive payment the general assembly has specified in law to be paid to nursing facilities for that fiscal year.

(E) The director of job and family services shall adopt rules under section 5111.02 of the Revised Code as necessary to implement this section.

Amended by 129th General Assembly File No. 28, HB 153, § 101.01, eff. 7/1/2011.

Effective Date: 07-01-2005; 06-30-2006